Ethical considerations: Mechanical Organs as a replacement of human organs

What are the ethical issues that affect the research subject, and how does the subject affect nurses? Introductions“Ethics, the philosophical study of morality, is the systematic exploration of questions about what is morally right and morally wrong. The study of ethics enables us to evaluate the variables that influence our moral decisions, obligations, character, responsibility, and social justice” (Keatings & Smith, 2000, p. 13). Ethical dilemmas and their ensuing challenges are a reality for nurses. Daily we are forced to challenge not only our personal thoughts and beliefs, but as well, those of our patients and families. Together we struggle with a) new technology, b) new vision, and c) the concept of the new normal. As outlined by Hansson (2005) there are numerous ethical considerations to mechanical organs such as a) donations, b) end of life decisions, c) distributive issues, d) disease concept and enhancement, e) mental change and personal identity, f) cultural effects, and g) non voluntary interventions. This paper will explore three such concepts: a) end of life decisions, b) mental and personal identity, and c) culture. It will also address how mechanical organs as a replacement for human organs has effected nurses. End of Life DecisionsHansson (2005) argues “it is reasonable to assume that patients who receive an artificial heart will regard it as their own, in much the same as they would regard their original heart or a transplanted one” (p. 522). Really, is that so? What about the patient who receives a Left Ventricular Assist Device (LVAD) as a means to bridge him to transplant, but is no longer deemed a candidate for transplantation? More recently coined as a means for destination therapy, is it still reasonable to be so presumptuous in his case, or do we turn off his LVAD at his request? There is significant psychosocial distress for a) patients, b) their families, and c) health care professionals when patients want to either abort treatment or refuse treatment. End of life decisions regarding mechanical organs have not been thoroughly researched. In fact bioethicists are still arguing over the terms to identify mechanical organs; they ponder between prosthesis versus implants (Simon & Fischbach, 2008). Life sustaining mechanical organs such as a) the heart, b) the lungs and c) the kidneys are of great interest to bioethical researchers, but to date there has been little resolution on how much power a patient should have once the mechanical organ is insitu.As argued by Hansson (2005), other concepts related towards end of life include: maintaining these mechanical organs when patients are declining, and adverse affects such as wound infections and sepsis. When we think of administration, often it comes down to the cost of these mechanical organs and all the care that is involved with them and the patient. Sustainability is always a concern and an ethical issue in health care when it pertains to end of life decisions.Mental and Personal IdentityThe concept of ethics is not easily understood. In 2008, Hansson argued“Utilitarianism assigns no value to the individual person, but only to the mental states carried by that person… on the other hand, deontological and rights based ethics assign their determining ethical relationships (duties respectively rights) to individuals” (p.524). These are two distinct ethical views. They are instrumental for the decision making personal. Regardless of who that person may be, and regardless of whether these actual terms are understood; they shape our morals and lead to our decisions. Another argument to mental and personal identity lies in the results of the decisions made. Patients may often struggle psychosocially by having acquired a mechanical organ. There can be changes to personality, both physical and mental when a patient obtains a mechanical organ. The struggle for personal identity can be challenged as one accepts or refuses a mechanical organ. A mechanical heart could invoke some deep critical thoughts around the notion of one’s soul. The implications for mental and personal identity can be far reaching. Thoughts of disconnection and disassociation can have significant impact on a patient’s quality of life. When transferring a synthetic organ into a conscious body, is the heart and soul still the same human being? “Faith in one’s body, in one’s ability to manage problematic situations, incorporation of pharmacologic and/or technical devices, and accepting ideas foreign to one’s culture, all involve identity change” (Redman, 2008, p. 818). The psychosocial well being of any mechanical organ transplant recipient cannot be negated. Cultural Effects“Medical technology, including implants, has effects not only on individuals but also on social groups and on society as a whole” (Hansson, 2005, p. 523). Two persons with the same affliction can have two entirely different perceptions of their definitions of health and disease. A group of Turkish parents for example, argue against cochlear implants for children. “They claim that large scale cochlear implantation of children would conflict with the right of the Deaf language and cultural minority to exist and flourish” (Hansson, 2005, p. 523). Their logic is simple, their children are not ill with disease. At the heart of this ethical dilemma remains the concept that culture or groups are more important than individuals. “The Catholic Health Association of Canada (CHAC) states that artificial substitutes for tissues and organs are permissible provided they "can fulfill an essentially beneficial human function in the recipient" and the "human dignity of the recipient" is not compromised in any way” (Flaman, n.d., n.p.). Many would consider this to be a bold statement from a powerful institution that captures such a large and often attentive audience. Quoting literature is not required to acknowledge the fact that Non Christian and non western societies have significantly different thoughts towards medical interventions; culture most definitely plays a large part in the ethics surrounding mechanical organs.Nursing ConsiderationsNursing considerations was included as part of this document because ethics, related to the subject of mechanical organs as a replacement for human organs, has had, and according to research, will continue to have large affects on the nursing culture. According to (Hermsen & van der Donk, 2009), when discussing dialysis, several themes prevail: a) stopping or continuing dialysis, b) patient non-compliance, c) patients’ wishes versus caregivers’ professional expertise, d) kidney transplantation, e) confidentiality, f) deciding not to resuscitate, and g) difficult patients. These concepts easily pertain to other patients requiring other mechanical organs such as the heart and lungs. A complete document could easily be written on each of these concepts themselves. These are huge dilemmas that nurses face daily when working with mechanical organ recipients. Nursing ethics is embodied in our philosophy, yet nurses have not quite figured out how to handle ethical dilemmas. Patients requiring mechanical organs are usually deemed to have some sort of a chronic ailment. Professional nursing responsibilities include patient teaching. “The expansion of preparing patients to self-manage chronic disease provides an excellent opportunity to support patient self-determination and better quality of care. It is important to remember that patient education is a moral endeavor that affects patient identity, agency, perceptions of self-worth and possibility” (Redman, 2008, p. 813). We live and work in an evidenced-based research environment. As new research evolves, the education knowledge gap grows significantly for nurses. Who educates the nurse who is supposed to educate the patient? Fiscal responsibility often result in cut backs, and often in a hospital environment, or community based programs, nursing is one of the first professions to be affected by lay offs, or being replaced by less academically inclined health care workers such as Registered Practical Nurses and unregulated workers. Although nurses must continuously update themselves, they must also be presented the opportunity to attend courses and workshops. United, we should argue against replacing the Registered Nurse in certain disease sites. Continuing with patient education, “Ethical lapses in patient education are largely unexamined. The most common error is usurping patient choice by assuming someone else’s goal (societal or provider), or depriving patients of the knowledge and skills to exercise choice” (Redman, 2008, p. 815). As nurses, we are often left to explain to patients and their families exactly what the physician just said to them. Patients are often provided with one choice; the alternative is not always provided; doing nothing is rarely a choice. Nursing educators require the expanded knowledge, skills and abilities to assist staff nurses with the research pertaining to mechanical organs as a replacement for human organs. Nurses require better education and support in the fields of communication skills and the topic of ethics itself. The nursing community is often left to accept what a physician thinks is best, but nurses are great patient advocates and should speak out when needed. Communication skills is paramount to any good nurse, yet many Registered Nurses struggle when it comes to patient advocacy and standing up against the medical profession when they truly believe that what is being offered is not in their patients best interest. In 2005, Woods argued “well-educated nurses continue to argue that their ethical contribution to health care situations is often received in ways that are either dismissive or condescending” (p. 6). The nursing profession has a long way to go when it comes to having their opinions valued. At times we may offer a contradictory point, but in the end, the physician is still the ordering party, and nursing often falls into complacency; when faced with adversity, we often back away. Negotiation skills and communication techniques are often undervalued; nursing leadership is crucial to the development of a strong nursing body.“Researchers have stressed to need for nursing leadership to advance change in health care organizations to create safer practice environments for patients” (Cummings, Midodzi, Wong, & Estabrooks. 2010, p. 331). With the introduction of the mandated degree in nursing, we are seeing the evolution of nursing leadership. Just recently released last month, (Midodzi et al., 2010) have shown that the contribution of nursing leadership in hospital environment does affect patient outcomes. To date nursing has had little to say on the subject of mechanical organs as a replacement for human organs, but our leadership is building, and our research capabilities are beginning to show strong capabilities. Research will soon argue empirically that nursing leadership contributes significantly to all facets of patient care.